相关生化指标在AECOPD伴呼吸衰竭患者中的水平变化及临床意义分析

doi:10.3760/cma.j.issn.1007-1245.2023.08.022

摘要/Abstract

摘要：

目的　探讨淋巴细胞比值（NLR）、降钙素原（PCT）、糖类抗原125（CA125）、D-二聚体（D-D）在慢性阻塞性肺疾病急性加重期（AECOPD）伴呼吸衰竭患者中的水平变化及临床意义。方法　回顾性选取2019年8月至2022年6月聊城市第二人民医院收治的AECOPD患者160例，依据是否合并呼吸衰竭，将其分为观察组（AECOPD合并呼吸衰竭）60例、对照组（AECOPD非呼吸衰竭）100例。观察组男40例，女20例，年龄56～85（67.54±5.67）岁，COPD病程2～16（5.03±1.49）年。对照组男65例，女35例，年龄57～84（66.94±5.61）岁，COPD病程2～17（5.12±1.57）年。检测两组酸碱（pH）值、血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）水平、第1秒用力呼气容积占预计值百分比（FEV1%）、血清NLR、PCT、D-D、CA125水平，并对上述水平进行分析。统计学方法采用t检验。结果　与对照组比较，观察组PaCO₂水平较高，PaO₂水平、FEV1%、pH值较低（t=30.19、24.53、18.72、27.24，均P<0.05）。观察组血清NLR、PCT、D-D、CA125水平均高于对照组（t=39.40、142.09、25.56、12.45，均P<0.05）。血清NLR、PCT、D-D、CA125水平与PaO₂水平、pH值均呈负相关（r=-0.733、-0.666、-0.695、-0.549、-0.762、-0.742、-0.673、-0.598，均P<0.05），与PaCO₂水平则呈正相关（r=0.651、0.679、0.784、0.684，均P<0.05）。结论　患者体内血清NLR、PCT、D-D、CA125水平越高时，机体内PaCO₂水平就越高，PaO₂水平、pH值则越低，其病情就越严重，临床可通过对上述各血清因子水平进行检测，以辅助临床医师对AECOPD伴呼吸衰竭患者的病情程度进行辅助判断，从而尽早对患者进行针对性治疗，改善患者的预后。

关键词:

慢性阻塞性肺疾病急性加重期, 呼吸衰竭, 血清学, 肺功能, 指标

Abstract:

Objective　To investigate the changes and clinical significance of lymphocyte ratio (NLR), procalcitonin (PCT), carbohydrate antigen 125 (CA125), and D-dimer (D-D) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied by respiratory failure. Methods　A total of 160 patients with AECOPD who were admitted to Liaocheng Second People's Hospital from August 2019 to June 2022 were retrospectively selected. According to whether they were combined with respiratory failure, they were divided into an observation group (AECOPD combined with respiratory failure) of 60 cases and a control group (AECOPD non-respiratory failure) of 100 cases. In the observation group, there were 40 males and 20 females; they were 56-85 (67.54±5.67) years old; the course of COPD was 2-16 (5.03±1.49) years. In the control group, there were 65 males and 35 females; they were 57-84 (66.94±5.61) years old; the course of COPD was 2-17 (5.12±1.57) years. The acid-base (pH) values, partial pressures of oxygen (PaO₂) partial pressures of arterial blood carbon dioxide (PaCO₂), percentages of forced expiratory volume in the first second (FEV1%) of the expected value, and serum levels of NLR, PCT, D-D, and CA125 in the two groups were detected and analyzed. t test was applied. Results　The PaCO₂ was higher and the PaO₂, FEV1%, and pH were lower in the observation group than in the control group (t=30.19, 24.53, 18.72, and 27.24; all P<0.05). The serum levels of NLR, PCT, D-D, and CA125 in the observation group were higher than those in the control group (t=39.40, 142.09, 25.56, and 12.45; all P<0.05). The serum levels of NLR, PCT, D-D, and CA125 were negatively correlated with PaO₂ and pH (r=-0.733, -0.666, -0.695, -0.549, -0.762, -0.742, -0.673, and -0.598; all P<0.05), and positively with PaCO₂ (r=0.651, 0.679, 0.784, and 0.684; all P<0.05). Conclusion　The higher the serum levels of NLR, PCT, D-D, and CA125 in patients, the higher the PaCO₂, the lower the PaO₂ and pH, and the more serious the disease. The detection of the above serum factors can be used in clinic to assist clinicians in making auxiliary judgment on the severity of AECOPD patients with respiratory failure, so as to give the patients targeted treatment as early as possible and improve their prognosis.

Key words:

Acute exacerbation of chronic obstructive pulmonary disease, Respiratory failure, Serology, Pulmonary function, Indicators

路秀芳田金静康亚丽.

相关生化指标在AECOPD伴呼吸衰竭患者中的水平变化及临床意义分析 [J]. 国际医药卫生导报, 2023, 29(8): 1131-1134.

Lu Xiufang, Tian Jinjing, Kang Yali.

Changes and clinical significance of related biochemical indicators in AECOPD patients with respiratory failure [J]. International Medicine and Health Guidance News, 2023, 29(8): 1131-1134.

参考文献

[1] 宋灵洁,李红,程曦.慢性阻塞性肺疾病患者下呼吸道病原菌与死亡影响因素研究[J].成都医学院学报,2021,16(4):477-481.DOI:10.3969/j.issn.1674-2257.2021.04.015.
[2] 王飞,聂森,黄小伟,等.CA125与PCT联合检测对慢阻肺急性加重期抗菌治疗的参考价值[J].中国医药科学,2017,7(7):122-124,144.DOI:10.3969/j.issn.2095-0616.2017. 07.036.
[3] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.慢性阻塞性肺疾病基层诊疗指南(实践版·2018)[J].中华全科医师杂志,2018,17(11):871-877.DOI:10.3760/cma.j.issn.1671-7368.2018.11.003.
[4] 罗德云,陈菊屏.NLR联合降钙素原对COPD急性加重期细菌感染患者预后价值探讨[J].天津医药,2019,47(10):1054-1057.DOI:10.11958/20190925.
[5] 刘继明,何双双,时鹏帅.血清D-D、PCT水平与慢阻肺急性加重伴Ⅱ型呼吸衰竭患者无创正压通气治疗预后的相关性[J].航空航天医学杂志,2022,33(7):793-796.DOI:10.3969/j.issn.2095-1434.2022.07.009.
[6] 黄红铭,陈旭,陈良春.PCT、CRP及6 h乳酸清除率对AECOPD患者合并呼吸衰竭的诊断及预后评估分析[J].中国实验诊断学,2021,25(1):13-16.DOI:10.3969/j.issn.1007-4287.2021.01.004.
[7] 莫如敦,石慧,韦玲,等.血清TREM-1、SAA检测在AECOPD并发呼吸衰竭诊断及预后评估中的价值[J].中国实验诊断学,2019,23(3):453-455.DOI:10.3969/j.issn.1007-4287. 2019.03.029.
[8] 孙芸,陆士奇,屠苏,等.血液标志物和心脏彩超检查在慢性阻塞性肺疾病急性加重期相关性肺动脉高压的评估价值[J].中国急救医学,2019,39(11):1058-1064.DOI:10.3969/j.issn.1002-1949.2019.11.010.
[9] 杨再兴,熊玮.盐酸氨溴索辅助治疗对AECOPD合并呼吸衰竭患者血气指标与肺功能的影响[J].山西医药杂志,2018,47(4):428-431.DOI:10.3969/j.issn.0253-9926. 2018.04.025.
[10] 李春梅,胡莺,陈晓霞,等.无创正压通气联合纤维支气管镜肺泡灌洗对老年AECOPD合并Ⅱ型呼吸衰竭患者肺功能及血气指标的影响[J].现代生物医学进展,2019,19(24):4752-4755.DOI:10.13241/j.cnki.pmb.2019.24.035.
[11] 张瑞超.温阳化痰祛瘀法对AECOPD合并呼吸衰竭患者血气指标及炎性因子的影响[J].淮海医药,2020,38(2):191-193.DOI:10.14126/j.cnki.1008-7044.2020.02.031.
[12] 杨俊杰.双水平气道正压通气对AECOPD呼吸衰竭患者血气指标及呼吸作功的影响研究[J].当代医学,2018,24(36):123-125.DOI:10.3969/j.issn.1009-4393.2018.36.054.
[13] 于珊玲,刘菲菲,徐淑凤,等.重症慢性阻塞性肺病急性发作期患者血清PCT,hs-CRP及D-D的表达及意义[J].现代生物医学进展,2017,17(18):3557-3560,3578.DOI:10.13241/j.cnki.pmb.2017.18.037.
[14] 宋文斌,杨林.血清PCT、D-D水平预测重症肺炎伴呼吸衰竭患者纤维支气管镜吸痰灌洗治疗效果的价值[J].河南医学研究,2021,30(27):5076-5078.DOI:10.3969/j.issn. 1004-437X.2021.27.026.
[15] 肖光军,李祥坤,魏容,等.血液中PLR、NLR及D-二聚体水平对AECOPD患者的预后价值评估[J].检验医学与临床,2019,16(8):1067-1070.DOI:10.3969/j.issn.1672-9455. 2019.08.017.
[16] 刘梅娟.血清Copeptin、D-D、PCT水平联合检测在AECOPD患者病情评估中的应用价值[J].医学理论与实践,2018,31(17):2646-2647.DOI:10.19381/j.issn.1001-7585. 2018.17.063.
[17] 谢伟国,刘澄英,唐良法.血清CA125水平在AECOPD并发呼吸衰竭患者中的表达及其意义[J].医学临床研究,2018,35(2):372-374.DOI:10.3969/j.issn.1671-7171. 2018.02.056.
[18] 刘霞,邱顺华,兰慧.血清CA125、NT-proBNP联合检测在AECOPD合并肺心病诊断中的临床价值[J].现代医药卫生,2022,38(3):463-466.DOI:10.3969/j.issn.1009-5519. 2022.03.025.
[19] 徐贤华,钟景页,彭华生,等.不同炎症程度的慢性阻塞性肺病患者CA125检测值分析[J].西南国防医药,2018,28(12):1224-1226.DOI:10.3969/j.issn.1004-0188.2018.12.033.
[20] 汪秀伟,余国庆.PCT、IL-6和NLR诊断慢性阻塞性肺疾病急性加重期的临床价值[J].国际检验医学杂志,2019,40(1):98-101.DOI:10.3969/j.issn.1673-4130.2019.01.026.